In Vitro Fertilization
In vitro fertilization is one of the most widely used assisted reproduction techniques in the world. Since 1978, when the first baby was born through this treatment, many couples try to achieve pregnancy through this technique that has revolutionized the world of science and human reproduction.
In Vitro fertilization (IVF) is a medical treatment consisting of medical and biological procedures aimed at facilitating the Union of OVA (oocytes) and sperm in the laboratory, to obtain embryos that will be introduced into the uterus in order to seek the opportunity to conceive couples or women with fertility problems.
From fertilization, embryos are obtained, which are the group of cells resulting from the progressive division of the ovum since it is fertilized. The objective is to generate a limited number of embryos in each treatment cycle to have reasonable chances of reproductive success.
A small number (usually 1 to 3) of the embryos obtained will be transferred to the uterus to achieve gestation. The remaining viable embryos, if any, will be retained and stored at very low temperatures (cryopreserved) to be used in the future for the purposes established.
The most common indications are:
- Absence, obstruction or injury to the tubes.
- Decreased number and/or mobility of spermatozoa or increased morphological alterations.
- Moderate or severe endometriosis.
- Ovulation alterations.
- Failure of other treatments.
- Advanced age.
- Requirement to receive donated eggs.
- Genetic diagnosis in the embryo (s) before implantation in utero (PGD).
Prior to the IVF process, the following evaluations will be made:
- Evaluation of the partner or husband that may include medical consultation, physical examination and laboratory examinations at medical discretion.
- Evaluation of the woman, with her medical history, physical examination and laboratory tests ordered by the specialist.
- Ovulation Induction:
In Vitro fertilization and sperm microinjection usually begin with the stimulation of the ovaries through the use of drugs, whose action is similar to that of certain hormones produced by the woman. The purpose of this treatment is to obtain the development of several follicles, inside which the eggs are found, controlling the moment of ovulation.
Several medications are used to stimulate the ovary and these can be taken by mouth.
The ovarian stimulation process is usually controlled with blood tests of ovarian hormone levels and/or transvaginal ultrasound that report the number and size of developing follicles. If you get the development of an adequate number of follicles, other medications are given to achieve the final maturation of the eggs.
- Egg collection (oocyte recruitmen)
The eggs are extracted by the puncture of the ovaries and aspiration of the follicles, under ultrasound vision and vaginally. This intervention is usually done in ambulatory regimen, under sedation. The woman can go home hours after recruitment, with antibiotic treatment and analgesic.
The eggs obtained are prepared and classified in the laboratory. The number of eggs extracted in the puncture, as well as their maturity and quality, varies according to the woman and cannot be accurately said.
- Sperm Sample Collection
A sample of fresh or previously cryo-preserved and stored sperm (from the partner or donor) must be provided on the day of Oocyte collection (it is advisable that this sample is delivered to the laboratory within the time of oocyte uptake) . The sperm sample is processed in the laboratory in order to separate and resuspend in the middle of the culture the best quality spermatozoa for the insemination of the eggs.
- Union of OVA and sperm
In vitro fertilization (IVF), OVA and spermatozoa are placed together in cultures, and incubated to let fertilization occur. It may be indicated to perform sperm microinjection (ICSI), due to major alteration of the spermogram or antecedent of failures of fertilization of the eggs, or unexplained infertility with failed intrauterine inseminations. The microinjection of each ovum is performed with a sperm (IVF with ICSI) and the fertilized eggs are incubated to allow the development of embryos.
The day after IVF or ICSI determines the number of fertilized eggs and in the successive days of cultivation the number and quality of the embryos that are still in development are assessed. The embryos will be kept in the laboratory for a period of 2 to 6 days after which the transfer will proceed.
Embryonic transfer consists of the deposit of embryos in the uterine cavity through the vagina. It is an outpatient procedure that usually does not require anesthesia. The embryos to be transferred are loaded into a thin probe or catheter that is then introduced into the uterus through the vagina to deposit the embryo (s) inside. For the purpose of promoting embryonic implementation, a hormonal treatment is prescribed after the recruitment.
The number of embryos transferred to the uterus should be limited to one or two and only in cases of older women or exceptional cases will be transferred to more embryos. Patients will receive from the biomedical team the information necessary to decide the number of embryos to be transferred in order to optimize the possibility of pregnancy and avoid multiple gestation as far as possible, understanding that the ultimate and ideal goal of this process is to procure a single pregnancy that results in the birth of a child. After embryo transfer, the woman should keep embryonic rest, the woman should keep bed rest (usually for one hour) and then be discharged with medical treatment hormonal treatment.
If there are good quality embryos not transferred from an in Vitro fertilization cycle, they can be cryopreserve and stored in liquid nitrogen.
In some cases, the usual IVF and ICSI techniques may be supplemented by other procedures on gametes or embryos intended to improve embryonic implantation capacity (assisted hatching, fragment extraction, genetic diagnosis Preimplantation, etc.).
The pregnancy test is done 15 days after the transfer. In this time interval the woman may need to perform hormonal blood measurements to adjust the dose of the hormone replacement medication.
The factors that condition the probability of gestation in an in vitro fertilization are: the cause of the infertility, the age of the woman, the number of eggs obtained and of final embryos of good quality.
However, it should be taken into account that not all patients initiating the treatment achieve and follicular development suitable for being punctured, and not all patients with ovarian puncture have embryo transfer, because in some cases the egg collection fails, the fertilization or embryonic development. Therefore, the result of the treatment can be expressed as percentage of gestations on the total of cycles initiated, on cycles with follicular puncture or on cycles with transference.
80% of the gestations are obtained in the first three cycles of IVF/ICSI with successful embryo transfer, so failure makes it necessary to discuss with the team the desirability of undertaking other treatments.
Between 40 and 60% of the patients obtain enough embryos to allow the preservation by vitrification of the untransfered supernumerary embryos (cryopreservation) taking into account that they will only be cryopreserved those with biological characteristics of viability.
When pregnancy does not occur, it is important to discuss the outcome of the cycle with the treating physician to evaluate each of the factors involved in the treatment process and define options for future improvement.
The probability of getting a pregnancy with an IVF cycle is greater than 45% in women under 35 years of age. It may vary according to factors such as the age of the woman, the duration of infertility and its cause. The cumulative total of the pregnancy rate after three treatment cycles may be 70 to 80%. For women, age may be the most influential factor because the number and quality of eggs in the ovaries decreases dramatically from 35 years of age.
Inser developed the comprehensive four-cycle program as a very beneficial alternative to the physical and emotional level for couples, because by increasing the number of attempts (4 fertilization and embryo culture), the success rate for achieving pregnancy can increase to 80%, something that reassures and excites the people involved in a highly complex fertility treatment.
One of the advantages of the comprehensive program of four cycles in vitro is that patients know that from its beginning, there are covered all possible changes that the specialist suggests to achieve pregnancy such as: embryo transfer , cryopreservation of OVA and sperm, fertilization by means of donors, etc. This makes the couple not have to worry about extra disbursements that were not included at the beginning of the treatment.
In addition, Inser’s comprehensive four-cycle program can become an opportunity for emotional empowerment that is very important for the couple, since the proper management of the process’s own situations allows the development of trust and nourishes perseverance in a common goal. In addition, it fosters personal and partner growth, improves emotional coping and effective response to unanticipated outcomes and strengthens hope, life project and decision-making and in common.
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If you need more information about this treatment.
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